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APPENDIX IV.
Treatment of Tuberculosis—Scheme for London.
(EXtract from, Council Minutes, 26th May, 1914.)
I.—Domiciliary treatment.
1. Domiciliary treatment of insured persons is secured by means of the panel practitioner.
Domiciliary treatment of uninsured persons is provided by private practitioners, district medical officers
and voluntary institutions, and, in so far as it may be incidental to dispensary treatment, by the medical
officer of the tuberculosis dispensary. The services of the latter are, in addition, available for purposes
of consultation.
11.—Dispensaries.
2. Dispensaries for the provision of treatment of persons suffering from tuberculosis will be provided
by, or arrangements for such provision will be made by, each local sanitary authority or by a
combination of local sanitary authorities.
3. In making or arranging for such provision the fullest possible use should be made of existing
suitable institutions in or near the local sanitary district. Provision should be made for treatment
at the dispensary of persons resident in the borough suffering from tuberculosis, or, in the case of a
combination of boroughs, persons resident in such boroughs, whether such persons are (i.) "insured"
within the meaning of the National Insurance Act, 1911, and recommended for " sanatorium benefit"
by the London Insurance Committee, and referred to the dispensary by the Committee or persons acting
under the authority of that Committee, or (ii.) persons not so insured.
4. The local authority in making their arrangements may either (i.) enter into an arrangement
with a hospital which lias available, or is prepared to make available, suitable dispensary provision,
(ii.) make arrangements with an existing tuberculosis dispensary, or (iii.) may provide, staff and equip
suitable premises for the purpose.
5. In addition to all other consents and approvals required by a local sanitary authority in respect
to its scheme of dispensary provison, the approval of the Council should be obtained. This approval
shall be given on the undermentioned conditions—
(1.) The Council must be satisfied that the premises to be utilised as a dispensary are
suitable for the purpose.
(ii.) The scheme must include provision, either in the dispensary, or at an hospital working
in connection with the dispensary, for the diagnosis not only of ordinary straightforward
cases, but also of incipient, anomalous, and difficult cases specially referred on the ground
of difficulty of diagnosis.
(iii.) The medical officer of the dispensary must be a man of experience, not only in dealing
with tuberculous affections, but also in general medicine.
(iv.) Proper records and statistics in connection with the work of the dispensary shall be
provided of the nature and in the form required by the Council and approved by the Local
Government Board.
(v.) The medical officer of the dispensary shall supply to the medical officer of health of
the borough from which the patients are drawn such information as the medical officer of health
may reasonably require, and the county medical officer of health shall be entitled to receive
this information from the borough medical officer of health. The medical officer of the dispensary
shall also furnish the requisite information to any medical practitioner carrying out
domiciliary treatment, or, in a case which is referred to a sanatorium, to the medical officer of
that institution.
(vi.) The scheme shall include provision for home visitation of patients, either by the
medical officer of the dispensary or by the medical officer of health of the borough and his
staff, and for the examination by the medical officer of the dispensary of such cases as the
medical officer of health or a medical practitioner may require, either at the dispensary or in
homes of suspects and contacts.
(vii.) The scheme shall be conducted with reasonable economy and the arrangements
and expenditure shall be annually submitted to the Council for its approval.
(viii.) The scheme shall provide for distinguishing clearly between the cost of treating
insured and uninsured persons.
(ix.) A dispensary shall be linked up with a hospital, to which special cases shall be referred
for consultation or treatment, residential or otherwise.
6. Local sanitary authorities may make arrangements to pay for patients, residing in districts
under their respective jurisdiction, attending dispensaries attached to hospitals in any part of the administrative
county of London.
7. Each local sanitary authority providing dispensary treatment should, if so requested by the
London Insurance Committee, make arrangements with that Committee for the treatment of such
"insured " persons as may be recommended for treatment by that Committee or by persons authorised
to act on behalf of the Committee, and such arrangements will, no doubt, provide for payment by the
Insurance Committee for such treatment.